=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891040754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAVORITE HEALTH CARE STAFFING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2012
-----------------------------------------------------
Last Update Date | 07/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 HIGHWAY 36 W SUITE 880
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55113-4034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-646-8046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 212 CHURCH ST S PO BOX 184
-----------------------------------------------------
City | BROWNS VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56219-2001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-499-0200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE
-----------------------------------------------------
Name | MRS. DONNA E HOFFMAN
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 612-499-0200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | R148513-2
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------